Tuesday Night Open Thread

Rough day at the dentist today. When I left with a prescription for pain medication, it came with a separate notice from the dentist, addressed to me, at my home address, advising me that when I fill the prescription, it will be entered in a state database accessible to law enforcement and doctors. 37 states are now enrolled in the prescription monitoring program. They are even working on an interstate version, having states share the information about your prescriptions with other states.

There's something wrong with this picture. Why should the private, personal medical information of millions of people be subjected to state surveillance and made accessible to law enforcement and thousands of pharmacists and health care providers, just so the Government can stop a few lawbreakers?

What if the database is breached or hacked, as happened in Virginia, exposing the medical information of 5 million people? The hackers demanded a $10 million ransom to return the information.

And interesting that recent research is telling us much more about freedwomen, long left out of too much African American history -- as recent research also is telling us much more about these daughters' daughters, the women who would lead the Great Migration northward to escape the anger toward them from postwar Southern whites:

In answering this letter, please state if there would be any safety for my Milly and Jane, who are now grown up, and both good-looking girls. You know how it was with poor Matilda and Catherine. I would rather stay here and starve--and die, if it come to that--than have my girls brought to shame by the violence and wickedness of their young masters. You will also please state if there has been any schools opened for the colored children in your neighborhood. The great desire of my life now is to give my children an education, and have them form virtuous habits.

I thought that was strange also. They quoted most of the letter and left that out. In fact, I found the paragraph particularly pointed and the article just diminished the content entirely. The letter did say that his children were happy and being educated, but the thrust of it was that his DAUGHTERS were SAFE.

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PS. And I am missing access to comment attributes. I don't what's up with Firefox.

on reasons for the Great Migration of African Americans, from a new perspective -- that of women. Turns out that they tended to be the first in their families, since women could get work first (as maids). And so much of the focus has been on lynchings of men as motivation to move north -- but for the first to come north, the motivation was escape from rape.

History looks so different when women are not, as in that excerpting, left out of the story. . . .

your toothache and pi$$ed off that big brother has yet another avenue into our privacy. Who tells them to set up state databases to monitor prescriptions? Vodka and Vicodin has always helped me with toothaches...now they'll know...

It seems like they tried to limit the scope of data to protect the privacy of the patient by only including medications. BUT...If you show me someone's med list I can pretty much tell you if they have HIV/AIDS. (or other conditions). I was unaware of entire state based program. Its very distrubing.

Does anyone know if as a patient, I get notification when someone views my identifiable data in these state based repositories?

Also, If they are using this for trending why isnt the information "de-identified"? Anyone know?

The HIPAA Privacy Rule carves out many exceptions to your ability to authorize release of your "protected health information," including details that identify you . As discussed earlier, you don't have the right to consent or object when your information is used for treatment, payment, or operations, including disclosures to business associates of your health care provider or plan. Each of these exceptions places conditions on the covered entity that makes the decision to disclose. But, you are out of the loop.

The flow of your medical information is beyond your control when the disclosure is made by a covered entity to or in connection with:

*Any disclosure required by federal, state, or local regulation, regardless of the scope of the disclosure or the purpose of the disclosure.
*Public health authorities.
*A person subject to the jurisdiction of the federal Food and Drug Administration.
*A person who may have been exposed to a communicable disease.
*An employer to (1) conduct workplace medical surveillance or (2) to evaluate whether you have a work-related illness or injury.
*Victims of abuse, neglect or domestic violence.
*A health oversight agency for audits and investigations.
*Court or administrative proceedings in response to a court order, subpoena, or discovery request.
*A collection agency for unpaid medical bills.
*Coroners and medical examiners.
*Funeral directors.
*Organ procurement organizations.
*A medical researcher with institutional review board approval.
*A threat to public safety or public health.
*U.S. and foreign military commanders.
*U.S. Department of Veterans Affairs to determine eligibility for benefits.
*Federal government national security and intelligence officials.
*U.S. Department of State to verify health fitness of employees and their families for foreign duty.
*Correctional institutions involved in health care of inmates.
*Workers compensation uses authorized by state law.
Further . . .

*Law enforcement access is authorized in a number of ways under HIPAA. In some cases information may be disclosed without a warrant or court order.

Bad choice of words. Each state gets to determine who and what gets access to the records. Many states have rules that are more stringent than HIPAA. And federal law would trump state law in the case that the state law did not go far enough.

been deleted for containing false information. Law enforcement does not need "probable cause" to access the prescription databases. Each state makes its own laws and in Colorado, for example, the information is accessible to law enforcement by either a court order or a subpoena.

Patients may receive their own personal data by contracting the PDMP. Law Enforcement may contact the PDMP to obtain prescriber or patient data. A court order or subpoena is required for such release

not doing his share is off base. He was seen strapping a very large, wiggling bag to the roof of his car heading out of Florida toward the ferry for the Caymans. It was either an anaconda or Newt--but a snake for sure. Not to worry, it was airtight.

For instance, if a patient is taking OxyContin, the prescriber would be able to review when the patient was first prescribed the drug, how many providers have prescribed for the patient, how often, and from what pharmacies the patient has received controlled drugs. The prescriber would determine whether the patient is taking the medication appropriately or making other uses of it.

as a receptionist said the same. She hewed to HIPPA religiously but saw so many co-workers not doing so that she got quite discouraged about it. (She has a health condition herself, much misunderstood, that some fools still use against employment.)